A nurse manager is implementing a quality improvement project to reduce the number of methicillin-resistant Staphylococcus aureus (MRSA) infections at the facility. Which of the following actions should the nurse manager take first?

A. Giving a glycerin suppository to a client for constipation: Medication administration, including rectal suppositories, requires assessment of bowel function, knowledge of contraindications, and evaluation of effectiveness, which fall under the responsibilities of a licensed nurse.

B. Evaluating the effectiveness of ibuprofen administered to a client who reported a headache: Assessing a client’s response to medication requires critical thinking, monitoring for adverse effects, and determining if additional interventions are needed, which are nursing responsibilities that cannot be assigned to assistive personnel.

C. Discussing dietary changes with a client who has a prescription for a gluten-free diet: Providing dietary education involves assessing the client’s current knowledge, identifying nutritional risks, and ensuring understanding of food choices, which requires professional nursing judgment or a consultation with a dietitian.

D. Measuring hourly urinary output for a client who is postoperative: Recording urinary output involves a simple measurement process that does not require clinical decision-making. Assistive personnel can accurately collect and document this data, allowing nurses to focus on interpretation and intervention if necessary.

A. The client has a do-not-resuscitate (DNR) prescription: Including the client’s code status is essential for ensuring that the receiving medical-surgical team follows the appropriate resuscitation plan. This information directly impacts emergency decision-making and aligns with the client's wishes.

B. The client has a continuous IV of lactated Ringer’s: Reporting active IV fluids is necessary for continuity of care, as it affects fluid balance, medication administration, and overall treatment planning. The receiving nurse must be aware of the infusion to monitor for effectiveness and complications.

C. The client was straight catheterized for 350 mL 2 hr ago: Details about recent procedures, such as urinary catheterization, are relevant to ongoing assessment and care. Monitoring urinary output helps evaluate kidney function and fluid status, making it crucial information for the next shift.

D. The client has Medicare insurance: Insurance details are important for administrative and billing purposes but do not directly impact immediate patient care. This information is typically managed by case management or the hospital’s financial services.

E. The client lives in a one-story home: While discharge planning may involve assessing home arrangements, this detail is not immediately necessary for a shift report. Relevant home considerations should be discussed later when planning for discharge and follow-up care.